Category: Health Insurance

The health insurance Marketplaces created under the Affordable Care Act have attracted nearly ten million enrollees, including many people who were previously insured by an employer-sponsored plan. The most popular Marketplace plan—the silver plan—has significantly higher cost sharing than does a typical employer-sponsored plan, which may cause patients to reduce the use of cost-saving services that are essential for managing chronic conditions.

Chronically ill people enrolled in individual health plans sold on the Affordable Care Act insurance exchanges pay on average twice as much out-of-pocket for prescription drugs each year than people covered through their workplace, according to a study published Monday in the Health Affairs journal.

Health insurers will lose about $2.5 billion because patients covered through President Barack Obama’s health law last year were sicker than expected, according to government figures released late Thursday.

The Department of Health and Human Services released updated numbers for a program that helps stabilize premiums in the health care law’s insurance markets, which offer taxpayer-subsidized private plans. Under that program, insurers whose medical claims costs were lower than expected pay in money to help insurers whose costs were higher.

Lackluster enrollment numbers, technology issues, and high maintenance costs are among the challenges plaguing ObamaCare state exchanges that were reviewed by the House Energy and Commerce Oversight Subcommittee at a hearing Tuesday.

“CMS has seemed more focused on doling out taxpayer dollars rather than overseeing how those dollars are spent,” Chairman Tim Murphy (R-PA) said of the lack of oversight.

Executives from six state exchanges—Oregon, Massachusetts, Hawaii, California, Minnesota, and Connecticut—provided testimony. So far, Oregon and Hawaii’s exchanges have both proven to be unsustainable, closing down and migrating consumers to HealthCare.gov’s federal marketplace with others likely to follow.

Chairman Murphy emphasized in his opening statement the sufficient amount of taxpayer money that was poured into creating these now-failing exchanges: “The Centers for Medicaid and Medicare Services has awarded $5.51 billion dollars to the States to help them establish their exchanges. Let me repeat that. The States received $5.51 billion in federal taxpayer dollars to set up their own exchanges. Yet, the ACA had no specific definition of what a state exchange was supposed to do, or more importantly, what it was not supposed to do.”

Grant money used to fund the exchanges was cut off in 2015 when states were expected to start bringing in enough money to continue operation on their own. Of the 17 states that chose to establish their own exchanges, nearly half face financial difficulties.

The committee hopes to find out why exchanges have struggled to become self-sustaining and whether or not any grant money will be recouped from states where exchanges have been shut down. For instance, Oregon spent $305 million of taxpayer dollars to establish its failed exchange, while Hawaii spent $205 million.

As Americans for Tax Reform points out, Tuesday’s hearing is a vital first step to addressing the urgent problems within the state exchanges—before they spread to all 17.

Bad news for New Yorkers, thanks to ObamaCare: More than 100,000 policyholders just learned that their Health Republic insurance plans will be canceled on Dec. 31. The start-up insurer (spun off from the Freelancers’ Union) is hemorrhaging red ink and has to close down.
That’s unfortunate for the policyholders, who now have to scramble to find other coverage and try to keep their doctors.

The enrollee share of premiums in the health insurance program for federal employees and retirees will rise by 7.4 percent on average in 2016, the largest increase since 2011, the government announced Tuesday.

Health Republic of New York, the largest Obamacare co-op in the country, was ranked as the worst health insurance company in complaints in 2014, according to the New York State Department of Financial Services.

State regulators ordered Health Republic Friday to stop writing insurance policies as it was no longer qualified to provide health insurance policies under New York state standards. Health Republic is the sixth of 23 health insurance co-ops funded by Obamacare since 2011 at a cost of $2.4 billion.

A federal program designed to aid federally created health plans such as the Louisiana Health Cooperative Inc. instead became the final nail in the ailing nonprofit’s coffin.

Louisiana Health — taken over by state regulators on Sept. 1 — was one of 23 plans created nationally under the Affordable Care Act to ensure there would be competition among health insurers. Altogether the co-ops received more than $2.4 billion in low-interest federal loans to get started. Only two have proven to be profitable amid restrictions that experts say have hampered the co-ops’ development.

On Tuesday, a Senate subcommittee is set to hear testimony from the chief executives of Aetna Inc., which plans to acquire Humana Inc., and Anthem Inc., which is seeking to buy Cigna Corp., as well as the head of the American Hospital Association.

The other big insurer, which isn’t testifying, is UnitedHealth Group Inc.

Members of Congress from both parties, as well as some employers, insurers and state insurance commissioners, are calling for changes in the Affordable Care Act to prevent premium increases that are expected to affect workers at many small and midsize companies next year.

Lawmakers see the potential for a rare bipartisan agreement on the issue, after five years in which Republicans have repeatedly tried to repeal the law and Democrats have blocked their efforts.